Connection and disconnection as predictors of mental health and wellbeing
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Klussman, K., Nichols, A. L., Langer, J., & Curtin, N. (2020). Connection and disconnection as predictors of
mental health and wellbeing. International Journal of Wellbeing, 10(2), 89-100. doi:10.5502/ijw.v10i2.855
ARTICLE
Connection and disconnection as predictors of mental
health and wellbeing
Kristine Klussman · Austin Lee Nichols · Julia Langer · Nicola Curtin
Abstract: Despite the established literature on connection to others, and burgeoning research on self-
connection, researchers have paid little attention to the equivalent experiences of disconnection that
people can experience in their everyday lives. The current research examined connection and
disconnection from oneself and others. Specifically, across two studies, participants listed up to
twenty words or phrases that they experienced related to each form of (dis)connection. Study 1
focused on how these affected participants’ mental health (i.e. anxiety and depression), while study 2
examined positive forms of wellbeing (i.e., flourishing and life satisfaction). Results suggested that
increased mental health was most strongly related to a greater experience of connection to others.
Flourishing also increased as one’s experience of other-connection increased. By contrast, poorer
wellbeing was related to a greater experience of disconnection from others. Finally, life satisfaction
decreased when participants experienced greater self-disconnection. In all, these findings provide an
initial test of and support for the continued examination of various forms of both connection and
disconnection.
Keywords: Self-Connection, Connection, Disconnection, Wellbeing, Mental Health
Introduction
Support abounds for the importance of connecting with others (Brown, Nesse, Vinokur, & Smith,
2003; Chu, Saucier, & Hafner, 2010; Tronick, 2005). In addition, self-connection, a new concept in
positive psychology, has also begun to receive support (Klussman, Curtin, Langer, & Nichols, 2020;
Klussman, Nichols, Curtin, & Langer, 2020a; 2020b). In particular, significant and consistent
relationships have emerged between it and several health and wellbeing indicators, including
mindfulness, meaning in life, and positive affect. However, connection is just one of the things that
people may experience when interacting with themselves and others. Similarly, despite significant
research focused on forms of disconnection (e.g., loneliness; Eisenberger, 2011), sparse evidence
exists for the effect of self-disconnection on health and wellbeing. This study attempts to build on
and extend past research by comprehensively examining the relationships between health,
wellbeing, and self/other (dis)connection.
Connection to Others
Research highlights the importance of being connected to others (Tronick, 2005). Connection to
others, often referred to in the literature as social support or belonging, includes factors such
89
Kristine Klussman
Connection Lab
Kristine@connectionlab.com
Copyright belongs to the author(s)Connection and Disconnection
Klussman, Nichols, Langer, & Curtin
as the provision or reception of resources to help people cope with stress, including physical aid,
emotional support, and/or knowledge dissemination (Cohen, 2004). Baumeister and Leary (1995)
assert that belonging is a fundamental human motivation. Relatedly, Heintzleman (2018) suggests
that wellbeing arises from the fulfillment of basic psychological needs, including relatedness to
others. As such, current operationalizations of connection in the literature suggest that it is both
important and a significant predictor of wellbeing.
Both the giving of social support (altruism) and the reception of it often result in greater
wellbeing and positive health outcomes (Brown, 2003; Tronick, 2005). In a longitudinal study of
older couples, Brown (2003) found that those who provided tangible and/or emotional support
reduced their risk of mortality by almost 50%. A recent meta-analysis also supported the relationship
between perception of social support and wellbeing (Chu, Saucier, & Hafner, 2013). Combined with
other research aimed at increasing wellbeing, the evidence seems strong that those receiving social
support experience increased wellbeing throughout the lifespan (e.g., Abby, Abramis, & Caplan,
1985; Chu, Saucier, & Hafner, 2013; Cohen, 2004).
Disconnection from Others
In theory, disconnection should involve a lack of these factors listed above (i.e., the opposite of
connection). However, as is the case with positive and negative affect (Watson, Clark, & Tellegen,
1984; 1988) and approach/avoidance tendencies (Carver, & White, 1994), we propose that connection
and disconnection are orthogonal constructs that independently affect a variety of outcomes. For
example, disconnection from others, often operationalized as loneliness or social isolation, has some
of the same neurobiological underpinnings as physical pain and can impact both physical and
emotional health (Eisenberger, 2011). Disconnection from others also often results in poorer health,
adjustment, and wellbeing outcomes (Baumeister & Leary 1995).
Without connection to others, infants and toddlers become distressed, and in extreme
circumstances, can develop physical and mental disorders due to a lack of human connection
(Tronick, 2005). In older adults, feelings of loneliness or disconnection from friends and neighbors
lead to decreased morale (Lee & Ishii-Kuntz, 1987). Furthermore, a meta-analysis found that
humans, when faced with rejection, will prioritize gaining back control of a situation, even if that
means acting anti-socially (Gerber & Wheeler, 2009). In fact, Levula, Wilson and Harré (2016) assert
that social isolation is the biggest predictor of mental health outcomes across the lifespan. Clearly,
disconnection from others is a negative experience in people’s lives and leads to several negative
outcomes. It also appears that these outcomes are quite different from those resulting from
connection to others.
Self-Connection
There is a clear and meaningful distinction between the self and others (Vorauer & Kumhyr, 2001).
In general, people respond differently to the same stimuli simply based on their current frame of
reference (Junghaenel et al., 2018). Consequently, self-other ratings are often different simply due to
whether the respondent is looking internally or externally (Atwater & Yammarino, 1997). Biological
research also suggests that distinct parts of the brain activate depending on whom one is currently
focused (David et al., 2006). Therefore, at least for people with an independent self-construal –– as
is common in Western societies –– the results of focusing on oneself versus others should differ
significantly (Markus & Kitayama, 1991). This highlights the importance of looking at connection
and disconnection as they refer to the self in addition to connection and disconnection from others.
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Klussman, Nichols, Langer, & Curtin
Past research has discussed self-connection as a combination of three components: (1)
awareness of oneself; (2) acceptance of oneself based on this awareness; and (3) alignment of one’s
behavior with this awareness (see Klussman, Nichols, et al., 2020a). Awareness of the self can be
thought of as understanding how one feels, thinks, and behaves, and what one’s values, goals, and
priorities are. Self-acceptance is an unconditional acceptance of these things one knows about the
self. Self-alignment occurs when there is congruence between one’s internal self and external
behaviors. To date, research supports the relationship between self-connection and wellbeing
(Klussman, Curtin, et al., 2020; Klussman, Nichols, et al., 2020a; 2020b).
Recent research supports this conceptualization and suggests that it is related to, but distinct
from, popular psychological concepts such as mindfulness and authenticity (Klussman, Nichols, et
al., 2020a). However, whereas mindfulness is often characterized as the non-judgmental awareness
of one’s internal states and experiences (Bishop et al., 2004; Carlson, 2013), and authenticity as
consistency between what others think of a person and his/her behavior (Barrett-Lennard, 1998),
self-connection uniquely requires awareness and acceptance of the self combined with acting in
alignment with that self. Without the acceptance of the self, one can be aware of who one is and act
in alignment with that but continue to feel dissatisfied with one’s existence (Klussman, Nichols, et
al., 2020a).
Self-Disconnection
Research has indicated that self-alienation is associated with mental distress and other negative
wellbeing outcomes (Wood, Linley, Maltby, Baliousis, & Joseph, 2008) and produces feelings of
discomfort and disconnection (Burks, & Robbins, 2012). In particular, self-disconnection has recently
been operationalized as a lack of at least one of the three components described above, i.e., self-
awareness, self-acceptance, and/or self-alignment (Klussman, Langer, Nichols, & Curtin, 2020a;
2020b). Preliminary qualitative evidence highlights the ease with which even self-proclaimed self-
connected people experience times of self-disconnection and the psychological distress that
accompanies it (Klussman, Langer, et al., 2020a). This research also suggests that being disconnected
from the self is a relatively common experience, even among those who are highly self-connected
(Klussman, Langer, et al., 2020a; 2020b). Despite this, relatively few studies have examined the
impact of being self-disconnected.
The first component is lacking self-awareness. People often struggle with understanding
how and why they make the decisions they do (Hofree & Winkielman, 2012; Vazire & Carlson, 2010).
Research shows that humans lack insight into how they feel and that introspection often leads to
incorrect conclusions (Wilson, 2004). In many instances, others are more adept at predicting how we
will react than we ourselves are (Vazire & Mehl, 2008; Vazire, 2010). Although not much is known
about the effects of this lack of self-awareness, recent research suggests negative effects for
personality development (Sheldon, 2014).
Lacking self-acceptance has also received relatively little consideration in the literature.
However, one can conceptualize this as similar to self-hatred, at its most extreme. In addition, the
combination of being highly unaware and unaccepting may be thought of as similar to symptoms
of dissociation thus resulting in a host of negative outcomes (Edge, 2004; Serlin, 2011). Finally,
researchers have found that, when one's behavior does not align with one’s internal selves, the result
is an experience of mental distress and discomfort (Burks & Robbins, 2012; Wood et al., 2008). This
may stem from the earliest theories of cognitive dissonance and lead to many negative internal
outcomes (Festinger, 1962).
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Klussman, Nichols, Langer, & Curtin
Current Research
In all, while researchers have independently examined the concepts of self and other connection and
disconnection, to varying degrees, researchers have not yet examined these concepts together as
they relate to mental health and wellbeing. The current research sought to expand our knowledge
of connection by examining self-connection and other-connection along with their disconnection
counterparts. In particular, we sought to understand how these various constructs affect both mental
health and wellbeing. Regarding mental health, we examined anxiety and depression, both being
factors that relate to connection and which should, therefore, be important for other forms of
connection and disconnection (Kawachi & Berkman, 2001; Klussman, Nichols, et al., 2020b).
Due to the consistent support for relationships between connection and wellbeing, we also
examined flourishing and life satisfaction as outcomes. Of note, these represent distinct types of
wellbeing—eudaimonia and hedonia, respectively (Disabato, Goodman, Kashdan, Short & Jarden,
2016). In addition to representing overall wellbeing, these constructs also relate to various other
positive outcomes. For example, Strine and colleagues (2008) found that increased life satisfaction
was associated with decreased health risk factors, such as smoking and heavy drinking, and
increased health related quality of life. Similarly, Keyes (2007) found that increased flourishing was
associated with increased psychological and physical health. Therefore, it is safe to say that both
forms of wellbeing are important and have implications for various aspects of a person’s overall
health.
In all, this study seeks to understand if there are relationships between self- and other-
(dis)connection, wellbeing, and mental health. We predicted that an increased experience of both
self- and other-connection would result in more positive and less negative outcomes, while an
increased experience of the equivalent forms of disconnection would result in less positive and more
negative outcomes. Although we did not have any guidance to hypothesize how the effects of each
experience would differ, we expected that the effects of connection and disconnection would be
independent from each other.
Study 1
Study 1 aimed to understand how self and other connection and disconnection relates to mental
health outcomes, including depression and anxiety. To examine our hypotheses, we recruited a
convenience sample and asked them to report on their experience of each form of (dis)connection,
followed by having them complete measures aimed at understanding their current mental health.
Method
Participants
Through personal contacts of those working in our lab, we recruited a total of 50 participants
who completed the entire online questionnaire. On average, participants were 33.38 years old (sd =
12.35), mostly White/Caucasian (78%), female (78%) and living in urban areas (56%).
Procedure
Once participants signed up and provided informed consent, they completed our online
questionnaire. As part of the main task of the study, we asked participants to list up to 20 words or
phrases that come to mind when they think of being self-connected, other-connected, self-
disconnected, and other-disconnected. For self-connection, we provided the following instructions,
“Please list the words or phrases that come to mind when you reflect on what it means, or feels like,
to be connected to yourself.” To do so, they filled in up to 20 boxes following the question, “When I
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experience deep connection to myself, I am or I experience: . . . ”. Similarly, to measure other-
connection, we provided these instructions, “Please list the words or phrases that come to mind
when you reflect on what it means, or feels like, to be deeply connected to other people.” and
participants answered this question, “When I am deeply connected to other people, I am or I
experience: . . . ”. Participants then turned to disconnection, again reporting up to 20 words or
phrases for both self-disconnection and other-disconnection. Specifically, “deeply connected” was
replaced with “disconnected” in the above instructions and questions.
Following this task, participants answered a variety of questions, including those related to
both anxiety and depression. We assessed anxiety and depression using the four-item version of
Kroenke, Spitzer, and Williams’ Patient Health Questionnaire for Depression and Anxiety (PHQ-4;
2001). Participants rated each item –– two for anxiety and two for depression –– on a four-point scale
(e.g., “Feeling nervous anxious or on edge”: 1= not at all; 4 = nearly every day). Higher scores reflect higher
levels of depression or anxiety respectively (MAnxiety = 1.88, sdAnxiety = 1.51, αAnxiety = .81; MDepression = 1.38,
sdDepression = 1.68, αDepression = .88). Participants then answered demographic questions.
Results
We began our analysis by creating our connection and disconnection-related variables from the task
participants completed. To calculate our measure of self-connection, we examined the self-
connection task and counted the number of boxes in which participants entered a word or phrase
(M = 6.22, sd = 4.41). We then did the same thing for self-disconnection (M = 5.34, sd = 4.36), other-
connection (M = 7.80, sd = 4.78), and other-disconnection (M = 6.94, sd = 4.33). As conceptualized,
these numbers represent the degree to which participants experience each construct.
We next performed four linear regression analyses—one for each type of (dis)connection (i.e.,
self or other) on each dependent variable (i.e., anxiety or depression). We first regressed anxiety
simultaneously on self-connection and self-disconnection. Neither connection to self (β = -.30, p =
.33) nor disconnection from self (β = .13, p = .68) resulted in a significant relationship with anxiety.
By contrast, a similar regression with other-connection and other-disconnection, entered
simultaneously, resulted in a significant effect of connection to others (β = -.62, p = .02) but not
disconnection from others (β = .31, p = .22). A similar set of analyses resulted in almost identical
effects on depression. The only significant effect was that of connection to others (β = -.54, p = .04).
All other effects were nonsignificant (all βs < .42, ps > .11).
Discussion
Findings from Study 1 suggest that neither one’s connection to oneself, disconnection from oneself,
nor one’s disconnection from others, seem to relate to levels of anxiety or depression. However, the
more that participants experienced connection to others, the lower their ratings of anxiety and
depression. That is, it seems that an increased experience of connection to others uniquely relates to
decreases in both anxiety and depression. However, self-connection did not appear to affect these
negative mental health outcomes. Similarly, disconnection from oneself nor from others related to
anxiety or depression. In all, this suggests that one’s mental health is most benefited from
experiencing connection to others. We further explore these effects in the context of wellbeing next.
Study 2
Study 1 suggested that only connection to others relates significantly to a person’s mental health. To
further examine our hypotheses, Study 2 sought to extend these findings to a person’s overall
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wellbeing. Using a similar procedure, we recruited an online sample of participants and examined
how (dis)connection related to their flourishing and life-satisfaction. Overall, we sought to
understand how self and other (dis)connection affects aspects of wellbeing and if these effects are
distinct for each form of (dis)connection.
Method
Participants
We recruited US residents from Amazon’s Mechanical Turk. A total of 101 participants
completed the entire online questionnaire. On average, participants were 35.05 years old (sd = 9.91),
mostly White/Caucasian (81%), female (55%), and living in suburban areas (55%).
Procedure
The procedure was almost identical to that in Study 1. Once participants signed up and
provided informed consent, they completed the online questionnaire. Participants first listed up to
20 words or phrases that come to mind when they think of being self-connected, other-connected,
self-disconnected, and other-disconnected. Following this task, participants answered a variety of
questions, including those related to wellbeing. Following these measures, participants answered
demographic questions.
Measures
Flourishing. We used Diener and colleagues’ (2010) flourishing scale as our indicator of
eudaimonic wellbeing. Participants rated how much they agreed with seven statements on a seven-
point scale (e.g., “I am a good person and live a good life”: 1= strongly disagree; 7 = strongly agree). The
original scale has 8 items, but one item (“People respect me”) was left out of our survey due to a
transcription error. Higher scores indicated greater flourishing (M = 5.13, sd = 1.41, α = .96).
Life Satisfaction. We measured life satisfaction, as our indicator of hedonic wellbeing, with
the single-item measure validated by Cheung and Lucas (2014). It asks participants to respond to
the following question on a four-point scale, “In general, how satisfied are you with your life?” (1 = very
satisfied; 4 = very dissatisfied). We reverse-coded the item so that higher values represented higher life
satisfaction (M = 2.79, sd = 0.92).
Results
Similar to Study 1, we first computed our connection and disconnection-related variables. To
calculate our measure of self-connection, we examined the self-connection task and counted the
number of boxes in which participants entered a word or phrase (M = 5.69, sd = 3.25). We then did
the same thing for self-disconnection (M = 4.74, sd = 2.87), other-connection (M = 7.17, sd = 3.41), and
other-disconnection (M = 5.30, sd = 2.66).
We next performed linear regression analyses for each type of (dis)connection (i.e., self or
other) on each dependent variable (i.e., flourishing or life satisfaction). When entered as
simultaneous predictors, neither connection to self (β = .06, p = .62) nor disconnection from self (β =
-.21, p = .10) significantly predicted flourishing. By contrast, a similar regression with other-
connection and other-disconnection, entered simultaneously, resulted in significant effects of both
connection to others (β = .29, p = .05) and disconnection from others (β = -.41, p < .01).
A similar set of analyses examined these effects on life satisfaction. Although connection to
oneself did not seem to predict life satisfaction (β = .13, p = .29), one’s experience of disconnection
from oneself did (β = -.34, p < .01). Similarly, disconnection from others significantly predicted lower
life satisfaction (β = -.34, p = .02) while connection to others did not (β = .20, p = .18).
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Discussion
The results of Study 2 suggest that it is one’s experience of connection to and disconnection from
others that most strongly relates to flourishing. The experience of self-connection and disconnection
did not seem to relate to levels of flourishing. By contrast, it appeared that disconnection was the
key to understanding a person’s life satisfaction. Both self- and other-disconnection related to lower
life satisfaction. As predicted, this suggests that connection and disconnection are independent
concepts that result in different outcomes. Furthermore, being connected or disconnected from the
self versus from others is experienced differently and uniquely impacts aspects of one’s wellbeing.
General Discussion
The purpose of the current research was to examine how the experience of connection and
disconnection affects one’s mental health and wellbeing. Further, we wanted to understand how
disconnection from self differs from disconnection from others in predicting these outcomes. To this
end, we conducted two studies, one focusing on mental health and one on positive wellbeing, to
determine how (dis)connection manifests in these ways. Study 1 suggested that it is experiencing
connection to others that matters most to mental health, and that people who experience more other-
connection are less anxious and depressed. Study 2 similarly found that an increased experience of
connection to others increased eudaimonic wellbeing (i.e., flourishing). Uniquely, self-disconnection
also related significantly to flourishing. Furthermore, only disconnection from self and others, and
not connection, related to hedonic wellbeing (i.e., life satisfaction).
Implications
Our results suggest differing avenues for increasing distinct types of mental health and wellbeing.
Researchers and practitioners alike may best promote mental health by finding ways to increase
social support. Hedonic wellbeing may, on the other hand, show the greatest improvement by
developing ways of decreasing both self- and other-disconnection. Finally, people may best address
eudaimonic wellbeing by increasing connection to others and decreasing disconnection from
oneself. With this in mind, future studies should investigate how to diminish both self- and other-
disconnection in ways that uniquely address both health and wellbeing, while increasing other
connection to increase mental health.
In all, it appears that connecting with oneself and others, while avoiding disconnection from
each, is vital to a happy, healthy life. Past research has already examined the relationship between
self and other connection and various health and wellbeing indicators (Kawachi & Berkman, 2001;
Klussman, Nichols, et al., 2020b). The current research is some of the first to extend the idea of
connection to disconnection from both self and others. Our findings suggest that self and other
connection and disconnection may be distinct processes affecting health and wellbeing. Much like
the study of positive and negative affect (Watson et al., 1988), connection and disconnection may be
thought of as orthogonal constructs that share similarities but are importantly distinct processes
with separate predictors and outcomes. This research, therefore, provides initial evidence that both
connection to and disconnection from oneself and others are important, distinct, and require further
investigation. Given the large effect sizes resulting from the current research, this is likely to be a
promising avenue for future research (Geerling & Diener, 2018).
One especially promising implication can be applied to both a personal improvement
practice as well as in clinical settings. In both contexts, it is valuable to understand what forms of
connection or disconnection may lead to the desired mental health or wellbeing outcomes. For
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example, if people desire improvement in life satisfaction, they can focus on ways to decrease the
disconnection they experience from themselves and others and engage in actions that will ideally
decrease this disconnection. Likewise, clinicians could help patients through this process by
identifying the cause(s) of that disconnection and working with the patient to both internally and
externally reduce it. However, if increased mental health is the goal, one should focus on increasing
connection to others. In this case, clinicians would want to identify ways to help patients connect
with others and help them through that process.
Limitations and Future Research
One limitation of the current study was its cross-sectional nature. Instead of manipulating who
completed which task or priming them with one form of (dis)connection, we simply asked all
participants, in both studies, to report on their experience of all four types of connection and
disconnection. The resulting data were correlational in nature. Additionally, the samples were
demographically similar and relatively small. Future research would be wise to use larger, diverse
samples and experimental designs to further examine these relationships and to determine if, in fact,
it is (dis)connection that causes these outcomes or if these “outcomes” result in (dis)connection.
Once researchers have confidence in the directionality and strength of these relationships,
future research is needed to find ways to increase connection and decrease disconnection. One way
that practitioners may promote these types of connection and avoid disconnection could be the well-
researched modality of daily diaries, as these can help people to reflect on moments of connection
and disconnection in their daily lives and promote intentional change (Ullrich, & Lutgendorf, 2002;
Miller, 2014). Another potentially interesting intervention, targeting both self and other connection,
would be the use of group meditation. Doing this in a group setting that fosters discussion of
participants “true selves” and promotes intentional change would reflect what many therapeutic
groups aim to accomplish and may reap the same benefits of connection (Huntly, Araya, &
Salisbury, 2012; Sloan, Feinstein, Gallagher, Beck, & Keane, 2013). Future research should also
consider the finding that other-connection may be beneficial for health outcomes, especially since
this has long been supported by previous research (Brown, 2003; Tronick, 2005; Eisenberger, 2011).
The development of interventions promoting other-connection and social support can further
increase people’s health while decreasing the risk of negative health outcomes.
Another interesting line of research would be to study the interactions between perceptions
of connection to others and connection to the self. Does the increase of one increase the perception
of the other? Is there a relationship between those who perceive themselves as self-connected and
their perceptions of connections to others? Does increasing one form of connection or disconnection
affect the other forms of (dis)connection? The answers to these questions will likely help guide
research and practice in this area, and are among just some of the many avenues that future research
may pursue.
Importantly, disconnection appears to predict distinct outcomes from connection. Research
should more thoroughly investigate the effects of self and other disconnection to identify ways
people might also avoid experiences of disconnection. Previous research has qualitatively examined
what prevents people from connecting to themselves (Klussman, Langer, et al., 2020b) and to others
(Smyth, Harries, & Dorer, 2011), finding both internal and external barriers. It would be beneficial
to examine these findings together to see if the overlap provides a point of intervention that would
allow practitioners to simultaneously decrease both self and other disconnection.
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Klussman, Nichols, Langer, & Curtin
Finally, future development of the measurement of these concepts is important. This study
measured connection and disconnection by asking participants to list words that represented their
experience of feeling connected or disconnected from themselves and others. We then summed these
and used them in our analyses to represent connection and disconnection scores. Future research
would benefit from validated measures of connection and disconnection for both the self and others.
Research into other-connection has often used scales such as the Social Provisions Scale (Cutrona, &
Russell, 1987) and the Norbeck Social Support Questionnaire (Norbeck, Lindsey, & Carrieri, 1983).
Similarly, the UCLA Loneliness Questionnaire is a common and validated measure of disconnection
from others (Russell, Peplau, & Ferguson, 1978). However, there is not yet a validated measure of
self-connection or disconnection. As the present research suggests, connection and disconnection
may be distinct constructs, so having measures of each construct would be useful for understanding
and investigating these concepts further (Klussman, Nichols, et al., 2020a).
Conclusion
The current research examined various forms of both connection and disconnection. Connection to
others significantly predicted anxiety, depression, and flourishing. Similarly, those who experienced
more disconnection from others had lower flourishing and life satisfaction while those experiencing
more disconnection from themselves experienced lower life satisfaction. These results suggest that
all forms of connection and disconnection are important and require further study. In all, it appears
that simply being connected to oneself and others leads to important gains in both mental health
and wellbeing.
Authors
Kristine Klussman
Connection Lab
Kristine@connectionlab.com
Austin Lee Nichols
Connection Lab
Julia Langer
Connection Lab
Nicola Curtin
Connection Lab
Publishing Timeline
Received 14 February 2019
Accepted 10 February 2020
Published 1 June 2020
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